Please fill out for your child before their Visual Perception Evaluation
Neuro Eval Info and Questionnaire
Information about Neuro-Optometric Examinations, and a Questionnaire to complete before the exam.
NOTE: This form is ONLY for patients who have had a concussion, mild brain injury, stroke, or any form of neurological insult like toxicity. If you’re unsure, please contact our office for further instructions.
Please have your child fill out this form, in their own handwriting, prior to his/her Visual Perceptual Evaluation.